C426 Paradigm
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School
Western Governors University *
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Course
426
Subject
Medicine
Date
Jan 9, 2024
Type
Pages
10
Uploaded by lolzwaffle
Course of Action One
–
Follow Bashir’s Wishes
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
•
What is the patient’s medical problem? Is the problem acute? Chronic? Critical?
Reversible? Emergent? Terminal?
o
Jamilah is having an acute heart attack.
Heart attacks are emergent and
need to be treated by cardiac catheterization.
The damage caused to the
heart is not reversible.
•
Using this course of action, describe, in full sentences, necessary considerations via
1.
Beneficence
a.
The treatment team wants to treat Jamilah with compassion and kindness
2.
non-maleficence
a.
The providers do have an ethical and legal duty to prevent Jamilah from
getting in harm’s way.
3.
Autonomy
a.
Jamilah has the right to choose her own medical treatment.
•
In what circumstances are medical treatments not indicated?
o
If the patient has an advanced directive not wishing treatment or has a DNR
in place.
•
What are the probabilities of success of various treatment options?
o
The probability of success is lower due to Jamilah having diabetes mellitus
(DM) and chronic obstructive pulmonary disease (COPD).
This also makes
the healing process even longer.
•
In sum, how can this patient be benefited by medical and nursing care, and how can harm
be avoided?
o
Treatment can potentially extend her life.
Otherwise, in a matter of days, she
will pass.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
•
Has the patient been informed of benefits and risks, understood this information, and
given consent?
o
Jamilah can only speak basic English, which has caused a communication
barrier.
Due to this, she has not been properly informed of the risks,
benefits, or able to give proper consent.
•
Is the patient mentally capable and legally competent, and is there evidence of
incapacity?
o
There have been no indications if Jamilah is incapacitated, mentally capable
or legally competent.
•
If mentally capable, what preferences about treatment is the patient stating?
o
Jamilah wishes to receive treatment that will save her life.
•
If incapacitated, has the patient expressed prior preferences?
o
There are no preferences made by Jamilah, so all medical decisions would be
made by next of kin.
•
Who is the appropriate surrogate to make decisions for the incapacitated patient?
o
If Jamilah were to become incapacitated, Bashir would be the one to make
decisions.
•
Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
o
Jamilah has shown no indications that she is unable to or unwilling to
cooperate. With the emergency department being able to run tests and the
statement made to the social worker shows that she wants to have her life
saved and is cooperative.
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, and Respect for Autonomy
•
What are the prospects, with or without treatment, for a return to normal life, and what
physical, mental, and social deficits might the patient experience even if treatment
succeeds?
o
Jamilah will not be able to live a normal life if she doesn’t receive treatment.
With treatment, there is a better chance that she will live a normal life
outside of the deficits she is already experiencing with her current core
morbidities.
•
On what grounds can anyone judge that some quality of life would be undesirable for a
patient who cannot make or express such a judgment?
o
There are no grounds where someone can judge the quality of life as
undesirable.
•
Are there biases that might prejudice the provider’s evaluation of the patient’s quality of
life?
o
Jamilah is a 90 year that is currently living in a nursing home with COPD
and DM.
This can be seen as someone that is waiting to die and doesn’t value
life as much as someone that is younger.
•
What ethical issues arise concerning improving or enhancing a patient’s quality of life?
o
Autonomy is a big concern when it comes to evaluating, improving, or
enhancing one’s quality of life. The patient is the only one that can tell you if
their life is worth continuing.
•
Do quality-of-life assessments raise any questions regarding changes in treatment plans,
such as forgoing life-sustaining treatment?
o
Questions are raised regarding changes in treatment plans when you look at
the support they will have once leaving the hospital.
But the patient is the
only judge for their quality of life.
•
What are plans and rationale to forgo life-sustaining treatment?
o
The current plan is for Jamilah to receive comfort care because the decision
was made by Bashir.
•
What is the legal and ethical status of suicide?
o
Some states approve Physician Assisted Suicide to those who are terminally
ill and would experience a painful death. Ethically, you should follow the
patient’s wishes if they would prefer suicide to end their misery related to the
life-threatening condition.
CONTEXTUAL FEATURES
The Principles of Justice and Fairness
•
Are there professional, interprofessional, or business interests that might create conflicts
of interest in the clinical treatment of patients?
o
A conflict of interest is currently between the social worker and cardiologist.
The cardiologist is doing what Bashir has wished for his mother, while the
social worker is going off what Jamilah said to her in a private conversation.
•
Are there parties other than clinicians and patients, such as family members, who have an
interest in clinical decisions?
o
Bashir owns a small market and is currently struggling financially.
This can
weigh heavily on his decision making.
He could potentially be the one that
has been paying for his mother’s stay in the nursing home and now for the
hospital.
His mother could have a life insurance policy that will help him get
over his financial burden once she passes.
•
What are the limits imposed on patient confidentiality by the legitimate interests of third
parties?
o
With a heart attack being an emergent situation, the patien
t’s next of kin can
receive medical information regarding diagnoses and treatments, unless it is
against the patient’s wishes, but they will need to be mentally competent
•
Are there financial factors that create conflicts of interest in clinical decisions?
o
If Jamilah doesn’t have health insurance, she will be responsible for all
costs. This burden could also fall onto Bashir. Cardiac Catheterization and
the possibility of coronary artery bypass (CABG) surgery can cause a big
financial burden on them.
•
Are there problems of allocation of scarce health resources that might affect clinical
decisions?
o
There was no mention of scarce health resources.
If there was, Jamilah
could no longer become a top priority due to her being 90 years old. The
hospital could cause a bigger impact helping those that are younger needing
the same emergent treatment.
•
Are there religious issues that might affect clinical decisions?
o
No religion was mentioned in the scenario, but most of Turkey is Islamic.
The Islamic culture believes in a patriarchal society, which would put
Bashir’s wishes over his mothers.
•
What are the legal issues that might affect clinical decisions?
o
The biggest legal issue would be if they didn’t follow Jamilah’s wishes.
If she
is in the right frame of mind to make her own medical decisions, but continue
following Bashir
, you are breaking the patient’s rights and could potentially
be classified as assault.
•
Are there considerations of clinical research and education that might affect clinical
decisions?
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o
There is no education or clinical research that could affect the clinical
decisions regarding Jamilah’s care.
•
Are there issues of public health and safety that affect clinical decisions?
o
There are currently no public health or safety issues to affect any clinical
decisions.
•
Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may
affect clinical decisions and patient welfare?
o
The social worker wants to honor Jamilah’s wishes and the cardiologist is
wanting to follow B
ashir’s wishes of comfort care.
This is causing a conflict
of interest between the two of them.
Course of Action Two -
Refuse to Follow Bashir’s Wishes
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
•
What is the patient’s medical
problem? Is the problem acute? Chronic? Critical?
Reversible? Emergent? Terminal?
o
Jamilah is having an acute heart attack.
Heart attacks are emergent and
need to be treated by cardiac catheterization.
The damage caused to the
heart is not reversible.
•
Using this course of action, describe, in full sentences, necessary considerations via
4.
beneficence
a.
The treatment team wants to treat Jamilah with compassion and kindness
5.
non-maleficence
a.
The providers do have an ethical and legal duty to prevent Jamilah from
getting in harm’s way.
6.
Autonomy
a.
Jamilah has the right to choose her own medical treatment.
•
In what circumstances are medical treatments not indicated?
o
If the patient has an advanced directive not wishing treatment or has a DNR
in place.
•
What are the probabilities of success of various treatment options?
o
The probability of success is lower due to Jamilah having diabetes mellitus
(DM) and chronic obstructive pulmonary disease (COPD).
This also makes
the healing process even longer.
•
In sum, how can this patient be benefited by medical and nursing care, and how can harm
be avoided?
o
Treatment can potentially extend her life.
Otherwise, in a matter of days, she
will pass.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
•
Has the patient been informed of benefits and risks, understood this information, and
given consent?
o
Jamilah can only speak basic English, which has caused a communication
barrier.
Due to this, she has not been properly informed of the risks,
benefits, or able to give proper consent.
•
Is the patient mentally capable and legally competent, and is there evidence of
incapacity?
o
There have been no indications if Jamilah is incapacitated, mentally capable
or legally competent.
•
If mentally capable, what preferences about treatment is the patient stating?
o
Jamilah wishes to receive treatment that will save her life.
•
If incapacitated, has the patient expressed prior preferences?
o
There are no preferences made by Jamilah, so all medical decisions would be
made by next of kin.
•
Who is the appropriate surrogate to make decisions for the incapacitated patient?
o
If Jamilah were to become incapacitated, Bashir would be the one to make
decisions.
•
Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
o
Jamilah has shown no indications that she is unable to or unwilling to
cooperate. With the emergency department being able to run tests and the
statement made to the social worker shows that she wants to have her life
saved and is cooperative.
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, and Respect for Autonomy
•
What are the prospects, with or without treatment, for a return to normal life, and what
physical, mental, and social deficits might the patient experience even if treatment
succeeds?
o
Ja
milah will not be able to live a normal life if she doesn’t receive treatment.
With treatment, there is a better chance that she will live a normal life
outside of the deficits she is already experiencing with her current core
morbidities.
•
On what grounds can anyone judge that some quality of life would be undesirable for a
patient who cannot make or express such a judgment?
o
There are no grounds where someone can judge the quality of life as
undesirable.
•
Are there biases that might prejudice the provider’s evaluation of the patient’s quality of
life?
o
Jamilah is a 90 year that is currently living in a nursing home with COPD
and DM.
This can be seen as someone that is waiting to die and doesn’t value
life as much as someone that is younger.
•
What ethical is
sues arise concerning improving or enhancing a patient’s quality of life?
o
Autonomy is a big concern when it comes to evaluating, improving, or
enhancing one’s quality of life. The patient is the only one that can tell you if
their life is worth continuing.
•
Do quality-of-life assessments raise any questions regarding changes in treatment plans,
such as forgoing life-sustaining treatment?
o
Questions are raised regarding changes in treatment plans when you look at
the support they will have once leaving the hospital.
But the patient is the
only judge for their quality of life.
•
What are plans and rationale to forgo life-sustaining treatment?
o
The current plan is for Jamilah to receive comfort care because the decision
was made by Bashir.
•
What is the legal and ethical status of suicide?
o
Some states approve Physician Assisted Suicide to those who are terminally
ill and would experience a painful death. Ethically, you should follow the
patient’s wishes if they would prefer suicide to end their misery re
lated to the
life-threatening condition.
CONTEXTUAL FEATURES
The Principles of Justice and Fairness
•
Are there professional, interprofessional, or business interests that might create conflicts
of interest in the clinical treatment of patients?
o
A conflict of interest is currently between the social worker and cardiologist.
The cardiologist is doing what Bashir has wished for his mother, while the
social worker is going off what Jamilah said to her in a private conversation.
•
Are there parties other than clinicians and patients, such as family members, who have an
interest in clinical decisions?
o
Bashir owns a small market and is currently struggling financially.
This can
weigh heavily on his decision making.
He could potentially be the one that
has been
paying for his mother’s stay in the nursing home and now for the
hospital.
His mother could have a life insurance policy that will help him get
over his financial burden once she passes.
•
What are the limits imposed on patient confidentiality by the legitimate interests of third
parties?
o
With a heart attack being an emergent situation, the patient’s next of kin can
receive medical information regarding diagnoses and treatments, unless it is
against the patient’s wishes, but they will need to be mentally c
ompetent
•
Are there financial factors that create conflicts of interest in clinical decisions?
o
If Jamilah doesn’t have health insurance, she will be responsible for all
costs. This burden could also fall onto Bashir. Cardiac Catheterization and
the possibility of coronary artery bypass (CABG) surgery can cause a big
financial burden on them.
•
Are there problems of allocation of scarce health resources that might affect clinical
decisions?
o
There was no mention of scarce health resources.
If there was, Jamilah
could no longer become a top priority due to her being 90 years old. The
hospital could cause a bigger impact helping those that are younger needing
the same emergent treatment.
•
Are there religious issues that might affect clinical decisions?
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
o
No religion was mentioned in the scenario, but most of Turkey is Islamic.
The Islamic culture believes in a patriarchal society, which would put
Bashir’s wishes over his mothers.
•
What are the legal issues that might affect clinical decisions?
o
The biggest legal
issue would be if they didn’t follow Jamilah’s wishes.
If she
is in the right frame of mind to make her own medical decisions, but continue
following Bashir, you are breaking the patient’s rights and could potentially
be classified as assault.
•
Are there considerations of clinical research and education that might affect clinical
decisions?
o
There is no education or clinical research that could affect the clinical
decisions regarding Jamilah’s care.
•
Are there issues of public health and safety that affect clinical decisions?
o
There are currently no public health or safety issues to affect any clinical
decisions.
•
Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may
affect clinical decisions and patient welfare?
o
The s
ocial worker wants to honor Jamilah’s wishes and the cardiologist is
wanting to follow Bashir’s wishes of comfort care.
This is causing a conflict
of interest between the two of them.
Course of Action Three- Delay Treatment
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
•
What is the patient’s medical problem? Is the problem acute? Chronic? Critical?
Reversible? Emergent? Terminal?
o
Jamilah is having an acute heart attack.
Heart attacks are emergent and
need to be treated by cardiac catheterization.
The damage caused to the
heart is not reversible.
•
Using this course of action, describe, in full sentences, necessary considerations via
7.
Beneficence
a.
The treatment team wants to treat Jamilah with compassion and kindness
8.
non-maleficence
a.
The providers do have an ethical and legal duty to prevent Jamilah from
getting in harm’s way.
9.
Autonomy
a.
Jamilah has the right to choose her own medical treatment.
•
In what circumstances are medical treatments not indicated?
o
If the patient has an advanced directive not wishing treatment or has a DNR
in place.
•
What are the probabilities of success of various treatment options?
o
The probability of success is lower due to Jamilah having diabetes mellitus
(DM) and chronic obstructive pulmonary disease (COPD).
This also makes
the healing process even longer.
•
In sum, how can this patient be benefited by medical and nursing care, and how can harm
be avoided?
o
Treatment can potentially extend her life.
Otherwise, in a matter of days, she
will pass.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
•
Has the patient been informed of benefits and risks, understood this information, and
given consent?
o
Jamilah can only speak basic English, which has caused a communication
barrier.
Due to this, she has not been properly informed of the risks,
benefits, or able to give proper consent.
•
Is the patient mentally capable and legally competent, and is there evidence of
incapacity?
o
There have been no indications if Jamilah is incapacitated, mentally capable
or legally competent.
•
If mentally capable, what preferences about treatment is the patient stating?
o
Jamilah wishes to receive treatment that will save her life.
•
If incapacitated, has the patient expressed prior preferences?
o
There are no preferences made by Jamilah, so all medical decisions would be
made by next of kin.
•
Who is the appropriate surrogate to make decisions for the incapacitated patient?
o
If Jamilah were to become incapacitated, Bashir would be the one to make
decisions.
•
Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
o
Jamilah has shown no indications that she is unable to or unwilling to
cooperate. With the emergency department being able to run tests and the
statement made to the social worker shows that she wants to have her life
saved and is cooperative.
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, and Respect for Autonomy
•
What are the prospects, with or without treatment, for a return to normal life, and what
physical, mental, and social deficits might the patient experience even if treatment
succeeds?
o
Jamilah will not be able to live a normal life if she doesn’t receive treatment.
With treatment, there is a better chance that she will live a normal life
outside of the deficits she is already experiencing with her current core
morbidities.
•
On what grounds can anyone judge that some quality of life would be undesirable for a
patient who cannot make or express such a judgment?
o
There are no grounds where someone can judge the quality of life as
undesirable.
•
Are there biases that might prejudice the provider’s evaluation of the patient’s quality of
life?
o
Jamilah is a 90 year that is currently living in a nursing home with COPD
and DM.
This can be seen as
someone that is waiting to die and doesn’t value
life as much as someone that is younger.
•
What ethical issues arise concerning improving or enhancing a patient’s quality of life?
o
Autonomy is a big concern when it comes to evaluating, improving, or
enhanc
ing one’s quality of life. The patient is the only one that can tell you if
their life is worth continuing.
•
Do quality-of-life assessments raise any questions regarding changes in treatment plans,
such as forgoing life-sustaining treatment?
o
Questions are raised regarding changes in treatment plans when you look at
the support they will have once leaving the hospital.
But the patient is the
only judge for their quality of life.
•
What are plans and rationale to forgo life-sustaining treatment?
o
The current plan is for Jamilah to receive comfort care because the decision
was made by Bashir.
•
What is the legal and ethical status of suicide?
o
Some states approve Physician Assisted Suicide to those who are terminally
ill and would experience a painful death. Ethically, you should follow the
patient’s wishes if they would prefer suicide to end their misery related to the
life-threatening condition.
CONTEXTUAL FEATURES
The Principles of Justice and Fairness
•
Are there professional, interprofessional, or business interests that might create conflicts
of interest in the clinical treatment of patients?
o
A conflict of interest is currently between the social worker and cardiologist.
The cardiologist is doing what Bashir has wished for his mother, while the
social worker is going off what Jamilah said to her in a private conversation.
•
Are there parties other than clinicians and patients, such as family members, who have an
interest in clinical decisions?
o
Bashir owns a small market and is currently struggling financially.
This can
weigh heavily on his decision making.
He could potentially be the one that
has been paying for his mother’s stay in the nursing home and now for the
hospital.
His mother could have a life insurance policy that will help him get
over his financial burden once she passes.
•
What are the limits imposed on patient confidentiality by the legitimate interests of third
parties?
o
With a heart attack being an emergent situation, the patient’s next of kin can
receive medical information regarding diagnoses and treatments, unless it is
against the patient’s wishes, but they will need to be mentally competent
•
Are there financial factors that create conflicts of interest in clinical decisions?
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
o
If Jamilah doesn’t have health insurance, she will be responsible
for all
costs. This burden could also fall onto Bashir. Cardiac Catheterization and
the possibility of coronary artery bypass (CABG) surgery can cause a big
financial burden on them.
•
Are there problems of allocation of scarce health resources that might affect clinical
decisions?
o
There was no mention of scarce health resources.
If there was, Jamilah
could no longer become a top priority due to her being 90 years old. The
hospital could cause a bigger impact helping those that are younger needing
the same emergent treatment.
•
Are there religious issues that might affect clinical decisions?
o
No religion was mentioned in the scenario, but most of Turkey is Islamic.
The Islamic culture believes in a patriarchal society, which would put
Bashir’s wishes over h
is mothers.
•
What are the legal issues that might affect clinical decisions?
o
The biggest legal issue would be if they didn’t follow Jamilah’s wishes.
If she
is in the right frame of mind to make her own medical decisions, but continue
following Bashir, yo
u are breaking the patient’s rights and could potentially
be classified as assault.
•
Are there considerations of clinical research and education that might affect clinical
decisions?
o
There is no education or clinical research that could affect the clinical
decisions regarding Jamilah’s care.
•
Are there issues of public health and safety that affect clinical decisions?
o
There are currently no public health or safety issues to affect any clinical
decisions.
•
Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may
affect clinical decisions and patient welfare?
o
The social worker wants to honor Jamilah’s wishes and the cardiologist is
wanting to follow Bashir’s wishes of comfort care.
This is causing a conflict
of interest between the two of them.